Total elbow arthroplasty for hemophilic osteoproliferative elbow arthritis with severe flexion contracture: A case report

Total elbow arthroplasty is effective for pain relief and the functional improvement of severe symptomatic hemophilic osteoproliferative arthropathy. Nevertheless, high complication rates have been reported. This report describes clinical results obtained at 30-month follow-up of total elbow arthroplasty in a hemophilic patient with severe flexion contracture. A 50-year-old patient with advanced left elbow hemophilic arthropathy underwent unlinked total elbow arthroplasty. He had sustained an intraoperative fracture of the medial part of a supracondylar humerus complication. To control perioperative bleeding, strict factor VIII replacement therapy was performed under the guidance of hematologists. The total elbow range of motion was 35° preoperatively, but it had improved to 110° postoperatively. The Patient-Rated Elbow Evaluation Japanese version score, which was 53.7 preoperatively, improved to 10.7 postoperatively. During the 30 months after operation, no complication occurred. Good clinical results have been obtained under close collaboration with hematologists and close patient adherence following treatment.

Assessment of anxiety related to Covid-19 in the elderly in Tunisia

Introduction

The COVID-19 pandemic has several risks particularly in the elderly, such a high death rate and severe forms.The risk also involves significant psychological distress especially anxiety.

Objectives

Assessment of anxiety symptoms due to COVID 19 in elderly subjects in Tunisia.

Methods

A cross-sectional descriptive study on a sample of 50 people aged between 65 and over. Data was collected using a questionnaire and a COVID Anxiety Rating Scale “Fear of COVID-19 Scale”.

Results

We found that most subjects agreed or strongly agreed that they were afraid of Corona and that 54% agreed or strongly agreed that they felt uncomfortable thinking about the Corona. Physical symptoms like having sweaty hands, or having palpitations related to the fear of having the disease were reported by 24% of the subjects. Almost half of the respondents (46%) were afraid of losing their lives due to Corona. Most subjects (66%) reported that they became nervous or anxious when viewing information posted on social media on Corona. Insomnia related to worries about having COVID was reported in 12% of subjects. We were able to retain that most of the subjects (68%) had a mild level of anxiety and that 30% of the subjects had a moderate level. No subject had severe anxiety.

Conclusions

Low to moderate level of fear due to the COVID 19 pandemic was observed among Tunisian elderly according to this study. This leads us to conclude that assessment of anxiety particularly in seniors should be more systematic.

Disclosure

No significant relationships.

Assessment of worries and attitudes towards the COVID-19 pandemic and the vaccine among Tunisian elderly

Introduction

The COVID-19 pandemic poses a threat particularly to the elderly. Although the current vaccination strategy is recognized as an adequate measure to reduce mortality, it still raises concerns about its efficacy and safety.

Objectives

Assessment of worries and attitudes among Tunisian elderly towards the pandemic.

Methods

A descriptive cross-sectional study on a sample of 50 consultants in a geriatric service, aged between 65 years and over. A questionnaire was formulated based on the recommendations of WHO and INEAS.

Results

The average age of our population is 74.6 years. The participants were mainly female, retired (76%) and with low educational attainment. Most of the elderly reported that they respected the wearing of the mask in public (90%) and washing their hands regularly (92%). Social distancing was respected by only 44% of the participants. Concerning the vaccine registration, we noted that 48% of the subjects expressed their willingness to register on the Evax.tn platform. On the other hand, 15 people expressed their refusal to receive the anti-Covid vaccine. We noted that only 22% had a dose of the Covid-19 vaccine. Only 4% of the respondents did not have concerns about new variants of the virus. About half (52%) of the subjects expressed significant concern about an increased risk of virulence and mortality due to the new variant. Vaccination was considered ineffective by most of the participants (70%).

Conclusions

Addressing worries about vaccine would be an important step to accept it among Tunisian elderly. Adequate information strategy is essential to change attitudes during the pandemic.

Disclosure

No significant relationships.

Closed rupture of a flexor profundus tendon to the little finger caused by asymptomatic pisotriquetral osteoarthritis: A case required differentiation from the tendon rupture due to hamate bony irregularity by bone erosion

Carpal joint osteoarthritis and the formation of bony irregularities of the carpal bone cause closed flexor tendon ruptures. This report describes a case of a flexor profundus tendon closed rupture of the little finger due to asymptomatic pisotriquetral osteoarthritis in a 73-year-old woman, which required differentiation from tendon rupture due to hamate bony irregularity due to bone erosion. Computed tomography showed cortical bone irregularities of the hamate and the narrowing of the pisotriquetral joint space, and a bony spur on the radial side of the pisiform. Intraoperative findings revealed the capsule of the pisotriquetral joint was torn on the radial side. Pisiform-hamate ligament disruption and the bony spur on the pisiform were found on this side. However, the flexor tendon floor on the hamate was intact. Surgical resection of the pisiform and a free tendon interposition graft for tendon rupture restored the good function of the little finger. Particular attention should be paid in making the diagnosis in cases with multiple possible triggers for closed flexor tendon rupture.

Successful Nonoperative Treatment of Osteochondritis Dissecans of the Humeral Capitellum in a Young Baseball Player with Advanced Skeletal Maturity

Background:

Osteochondritis dissecans (OCD) of the humeral capitellum presents most typically in adolescent athletes who perform repetitive overhead activities. Earlier studies have demonstrated that conservative treatment of OCD is appropriate for patients with an open capitellar growth plate from the standpoint that spontaneous healing can be expected.

Case:

A 12-year-old male baseball player with two years of experience with a local team participated in our medical check that included screening for capitellar OCD using ultrasonography. The subject experienced elbow pain when throwing, and ultrasonographic elbow examination indicated OCD of the capitellum, detected as irregularity of the subchondral bone of the capitellum. The initial radiograph, taken with the elbow at 45° of flexion, identified new bone formation in the lateral aspect of the OCD lesion; however the epiphyseal lines of the capitellum and lateral epicondyle were closed. We advised the patient to stop heavy use of the elbow, e.g., throwing and batting, and started conservative treatment in anticipation of spontaneous healing. Physiotherapy focusing on the shoulder girdle, core, and hip and lower limb stretches were performed to resolve general tightness. The OCD lesion had healed completely 12 months after the start of conservative treatment.

Discussion:

Conservative treatment for young baseball players might be worth considering if lateral new bone formation within the OCD lesion is detected on radiographic findings, even if the epiphyseal lines of the capitellum and lateral epicondyle are closed.

Cubital tunnel syndrome with small occult ganglion: A case report of bike rider

Cubital tunnel syndrome, the second-most common peripheral compression neuropathy, is associated with dynamic pressure in the cubital tunnel with the elbow flexion position. Medial elbow ganglion originated from the ulnohumeral joint causing cubital tunnel syndrome has been reported. This report describes the case of a 48-year-old man who developed numbness in his left ring and little finger after prolonged motorbike touring. He gradually showed decreased hand grip strength with medial elbow joint pain. Ultrasonography and magnetic resonance images revealed small occult ganglion at the medial side of elbow joint. Surgical resection of ganglion and ulnar nerve decompression relieved the ulnar neuropathy symptom. Prolonged motorbike riding while maintaining the elbow flexion position might exacerbate the symptom of cubital tunnel syndrome in patients with even a small space-occupying lesion such as the small occult ganglion.